Provider First Line Business Practice Location Address:
9311 HIGHWAY 24
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT YATES
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58538-9621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-854-3452
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2006